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APPLICATIGr R SANITATION PERMIT s (Complete in Duplicate) Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. t This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_..._. 5` 4E 3i3-..-----------S � kG� .3 ��,-a d. E Owner's Name €V ,tO3? �?gIm--------------------------------------------------------------------------------------------------------- Phone--- '!-612_6------------- Address------------- -----------Address---------------------- Contractor's Name------- ' p�*'r ,y Yt. E g 3I?�#------------ ----------------------- Phone--------&L859�-- Installation will serve: Residence [k Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms 12 Number of baths El Lot size_____3r,�_r ; �3q}--_______ -------------------- Water Supply: Public system ❑ Community system ❑ Private [it 1 Character of soil to a depth of 3 fee+: Sand E] Gravel E] Sandy Loam E] Clay Loam C] Clay Clay ❑ Adobe ' Hardpan [XN TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitfsJ-i{pu6jjc,x4w is available rrithin,200 feet.] f Septic Tank: Distance from nearest well---------- "'`Distance from foundation-------_------------Material .__________________-____________ ❑ No. of compartments =--f-----------City-----------------------Size-------------------- ' -------- Capacity --------------------------------Liquid depth--------------------------- Cesspool: Distance from nearest well._______________Distance from foundation--------------------Lining maferial------------------------_ ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- Privy: ------------------------------------------------Privy: Distance from nearest well_________________"______________________---------Distance from nearest building-------------- ------------------------- 171 Distance to nearest lot line____._"_________________________________________ Seepage Pit: Distance to nearest well_!_±?5.1-----------Distancessat_foundation____f R_ "_.Distance to nearest lot line----"_!-------- E Number of pits______-------------Lining mate4- yr-,n� f_ ize: Diamefer-----'q__ --"-P Depth-- f, .. _ �----------------------- Disposal Field: Distance from nearest well________________-Dist. ' C --------------------Distance to nearest lot line-________________ ]I ❑ Number of lines-_-_----_------------------------Length of each line--------_---------------------Width of trench---- Type of filter material_________________________Depth of filter material____________---_"______ Remodeling and/or repairing (describe):--- r `= a2x. Q1---$'t33- ' nwE% -------------- ----------M-------------------- ---------------------------- ----------- I -------"--------•--------------------------------------------------- ------------------•-----------•-------------------------------- ------•-- --- ------------------------------------------------------------------------------------------------------------------------------- = - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Courcy ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. k (Signed)... EfI.`-maxTI t- �{ ,/ Contras j 1 j -. 5'�1 . By::__ � z.._ (Title) r for ------- �... - - - -- -- ---- -- ------ ------------- --- --------------------------- (Piot pl ns, owing size of lot, location of s tem in relation to wells, buildings, e+c., must be filed with this application). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYDATE ------ -------- ---------- REVIEWED BY -------------------- = ---------------------------------------- -------------------------------------- DATE-----------�` = BUILDING PERMIT ISSUED-------�' = r "----- - --------------- --------------------- DATE----------------------- - ---��-------------- - - ----------------------------------- A terations and/or recommenda+ions------------------- --------------•----------------------------------- -------------------------------------•--------------------------------•--------------------------------------•-------------------------------------"-- ---------------•------------------------------------------------------- -------------------------------------------------------------------------------------- --------------- - ' --- ------------------ ------------ PERMIT No---------- --- 1 ISSUED__4 _ �'_ i� _,�'� ----;_[Date] FINAL WSPECTION BY:_ ___ __ ____ __ _ ------------- ----------------------- Date------.-----x/_ � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Stockton, California ES-9-2M 4-50 W-1639 f< ;